Chronic pancreatitis

Chronic pancreatitis is a chronic, often relapsing disease, which is based on constriction or blockage of pancreatic ducts, stone formation. Often is the result of acute pancreatitis, with a prolonged course of the disease there is exo-and endocrine pancreatic insufficiency. Primary chronic pancreatitis occurs with cholelithiasis, allergies, alcoholism, endocrinopathy. Clinical manifestations are not expressed and are often determined only in the final stage in the occurrence of exocrine insufficiency with digestive disorders or insulin-dependent diabetes mellitus.

Symptoms: paroxysmal or persistent pain of increasing intensity in the upper half of the abdomen with irradiation in the lower back and shoulder-straps. In some cases, mechanical jaundice develops due to compression of the common bile duct. With painless form, there is a malnutrition and diabetes mellitus. When examined: patients with reduced nutrition, lie with the knees brought to the stomach. With palpation of the abdomen - rigidity of muscles and tenderness in epigastrium, very rarely it is possible to probe a painful formation. Possible icterus of the skin. Sometimes due to compression or thrombosis of the splenic vein, splenomegaly occurs. With an overview radiographic examination of the abdominal cavity organs, calcium calcites can be detected along the course of the pancreas, and in the contrast study of the stomach and duodenum - displacement of the posterior wall of the antrum and unfolded horseshoe. Retrograde pancreatocholangiography, ultrasound examination of the pancreas is effective in diagnosis.

Differential diagnosis is performed with pancreatic cancer, which often presents difficulties even at the time of surgery, in connection with which puncture biopsy is used.

Treatment depends on the nature of the leading pathogenetic link of the disease: when combined with cholelithiasis produce cholecystectomy. When the pancreatic ducts narrow, they are retrograde drained by pancreatic neuralgia. In inducible pancreatitis accompanied by severe pain syndrome, subtotal pancreatectomy is indicated. The prognosis is serious, frequent recurrences of the disease, even after surgical treatment.